Pre-transfusion testing only necessary for select degenerative cervical spine surgery patients

Jorge H. Núñez

Pre-transfusion testing for all patients undergoing degenerative cervical spine surgery is unnecessary and only patients with preoperative haemoglobin (Hgb) lower than 12 gr/dl would routinely need pre-transfusion testing. This is according to new research, published recently in the journal Transfusion by Jorge H. Núñez (University Hospital of Mutua Terrasa, Barcelona, Spain) et al.

The study authors note that blood loss warranting transfusion “is a relatively rare requirement for degenerative cervical spine surgery”. However, despite this “pre-transfusion testing has become routine in most parts of the world”.

The researchers sought to determine if routine testing is necessary for patients who undergo degenerative cervical spine surgery in specialty surgical hospitals by measuring the current rate of intraoperative transfusions in degenerative cervical spine surgery and identifying risk factors for transfusions.

A retrospective review was performed on patients who underwent degenerative cervical spine surgery in two institutions. Demographic and baseline clinical and laboratory data were collected and analysed to identify predictors of transfusion. Bivariate and multivariate logistic regression analysis was performed to identify perioperative transfusion risk factors.

Out of a total of 372 patients, the overall transfusion rate was 1.9% (7/372), with no emergent transfusions. Decreases between preoperative and postoperative haemoglobin and haematocrit were 1.4% (standard deviation [SD] 1.1) g/dL and 7.2% (SD 4.1) respectively.

Multivariate logistic regression identified preoperative Hgb lower than 12 gr/dl (odds ratio [OR] 27.62; 95% confidence interval [CI] 4.31–176.96; p<0.001) as a significant independent transfusion risk factor. In addition, the receiver operating characteristic curve for the model showed a very good discriminatory power with an area under the curve of 0.91.

Speaking to Spinal News International, Núñez said: “It is essential to manage blood bank resources and organise blood ordering practices in a way that results in effective utilisation and minimal wastage of blood products. Even though blood is donated, its processing after donation and the amount of work involved in this process makes it expensive. Blood is among the 10 most expensive fluids in the world. Also, blood reserves are not infinite.

“Over the years, substantial improvement has been observed in the perioperative management of patients undergoing degenerative cervical spine surgery, which has made it possible, among other things, to reduce blood loss during these procedures.

“However, at our institution, as at other institutions in Spain, routine pre-transfusion testing is still performed and two units of packed red blood cells still are reserved for, following the maximum surgical blood ordering schedule (MSBOS) model developed in 1970.

“Our results indicate that it might not be necessary to request pre-transfusion testing for all patients undergoing a degenerative cervical spine surgery. Optimising preoperative management to maintain a preoperative haemoglobin level greater than 12 g/dL is recommended.”


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